COOK水囊在瘢痕子宫足月妊娠阴道分娩中的应用

Application of COOK water bag in vaginal delivery of uterine scar term pregnancy

目的探讨COOK球囊联合缩宫素在瘢痕子宫足月妊娠计划阴道分娩过程中催产的应用价值,以供临床参考。方法选取2014年8月至2017年10月在湖南省妇幼保健院剖宫产术后2年再孕的足月妊娠,有阴道试产条件,要求阴道分娩的患者180例,随机分为两组,实验组采用宫腔置入COOK球囊后12小时未临产静滴缩宫素催产,对照组采用林格氏液500mL+缩宫素2.5IU静滴。分析比较两种方法对促宫颈成熟的效果、阴道分娩率、剖宫产率、平均总产程、平均产后出血量(只算产后2小时内)的情况,以及两组引产方法不良反应。结果 COOK球囊及缩宫素促宫颈成熟成功率分别为73.33%和53.33%,差异有统计学意义(χ2=6.914,P<0.05);COOK球囊组剖宫产率26.67%,缩宫素组剖宫产率46.67%,两组比较差异有统计学意义(χ2=6.914,P<0.01)。两组发生产后2小时出血、产褥感染及新生儿Apgar评分比较差异无统计学意义(P>0.05)。结论COOK球囊联合缩宫素引产方法简单、效果优于单纯缩宫素引产,降低了剖宫产率,不增加母婴并发症。特别对于宫颈Bishop评分小于6分、内口紧的瘢痕子宫患者,效果更佳。

Objective To explore the application value of COOK balloon combined with oxytocin in the vaginal delivery of uterine scar term pregnancy.Methods Totally 180 cases requiring vaginal delivery with condition of trial delivery 2 years after cesarean section were selected in Hunan Province Maternal and Child Health Hospital.They were divided into experiment group receiving intravenous drip of oxytocin without labor after putting COOK balloon for 12 hours and control group using Ringer＇s solution500 mL and 2.5 IU oxytocin intravenously.Cervical ripening effect,vaginal delivery rate,cesarean section rate,average total labor,average amount of postpartum hemorrhage（only 2 hafter birth）as well as adverse reactions of induction method were compared between two groups.Results Success rate of COOK balloon and oxytocin for cervical ripening was 73.33% and 53.33%,respectively with significant difference（χ2=6.914,P0.05）.Cesarean section rate in COOK balloon group was 26.7%,and that in oxytocin group was 46.7%.The difference was statistically significant（χ2=6.914,P 0.05）.Incidence of 2 hpostpartum hemorrhage,puerperal infection and neonatal Apgar score had no significant difference between two groups（P0.05）.Conclusion Cook balloon combined with oxytocin method is simple and the effect is better than that of oxytocin,which reduces the rate of cesarean section without increase of maternal and infant complications.Especially for patients with cervical Bishop score less than 6 and those with uterine scar,the effect is better.